Provider Demographics
NPI:1427475649
Name:PATEL, SIRI J (MD)
Entity type:Individual
Prefix:DR
First Name:SIRI
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIRI
Other - Middle Name:J
Other - Last Name:RAMBHATLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1315 S GLENDORA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5140
Mailing Address - Country:US
Mailing Address - Phone:626-914-0174
Mailing Address - Fax:
Practice Address - Street 1:1315 S GLENDORA AVE STE 150
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5140
Practice Address - Country:US
Practice Address - Phone:626-914-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10115000208000000X
390200000X
CAA148531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program